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Original Article
Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021
Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi
Epidemiol Health. 2023;45:e2023086.   Published online September 17, 2023
DOI: https://doi.org/10.4178/epih.e2023086
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  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels.
METHODS
We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model.
RESULTS
The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening.
CONCLUSIONS
Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.
Summary
Korean summary
이번 연구는 한국의 대장암 검진에서 사회경제적 수준에 따른 불평등이 있는지를 분석했다. 국가암검진사업 도입 이래로 2009-2021년 연구기간 동안 공공검진을 통한 대장암 수검률은 지속적으로 증가한 반면, 개인검진의 증가는 관찰되지 않았다. 특히 공공 검진의 경우 소득이나 교육수준에 따른 수검률에 차이는 없는 반면, 개인검진에서는 상당한불평등이 관찰되었다.
Key Message
"The study investigated socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We found that the introduction of the National Cancer Screening Program for CRC effectively increased the participation rate, regardless of the SES of the individuals throughout the study period. However, significant inequalities were observed in opportunistic screening related to education and income."

Citations

Citations to this article as recorded by  
  • Health screening disparities in people living with HIV; A nationwide organized screening setting
    Boyoung Park, Yoonyoung Jang, Taehwa Kim, Yunsu Choi, Kyoung Hwan Ahn, Jung Ho Kim, Hye Seong, Youn Jeong Kim, Jun Yong Choi, Joon Young Song, Shin-Woo Kim, Sang Il Kim
    Journal of Infection and Public Health.2024; 17(12): 102567.     CrossRef
  • Disparities in Cancer Incidence across Income Levels in South Korea
    Su-Min Jeong, Kyu-Won Jung, Juwon Park, Nayeon Kim, Dong Wook Shin, Mina Suh
    Cancers.2023; 15(24): 5898.     CrossRef
Cohort Profile
Integrated database-based Screening Cohort for Asian Nomadic descendants in China (Scan-China): Insights on prospective ethnicity-focused cancer screening
Yuelin Yu, Liying Qiao, Jing Han, Weiwei Wang, Weiwei Kang, Yunjing Zhang, Shu Shang, Ruogu Meng, Lin Zhuo, Siyan Zhan, Yunfeng Xi, Shengfeng Wang
Epidemiol Health. 2023;45:e2023048.   Published online April 18, 2023
DOI: https://doi.org/10.4178/epih.e2023048
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  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Established in 2017, the Screening Cohort for Asian Nomadic descendants in China (Scan-China) has benefited over 180,000 members of a multi-ethnic population, particularly individuals of Mongolian descent compared with the general population (Han ethnicity), in the Inner Mongolia Autonomous Region, China. This cohort study aims to evaluate the effectiveness of cancer screening and serve as a real-world data platform for cancer studies. The 6 most prevalent cancers in China are considered—namely, breast, lung, colorectal, gastric, liver and esophageal cancer. After baseline cancer risk assessments and screening tests, both active and passive follow-up (based on the healthcare insurance database, cancer registry, the front page of hospital medical records, and death certificates) will be conducted to trace participants’ onset and progression of cancers and other prevalent chronic diseases. Scan-China has preliminarily found a disproportionately lower screening participation rate and higher incidence/mortality rates of esophageal and breast cancer among the Mongolian population than among their Han counterparts. Further research will explore the cancer burden, natural history, treatment patterns, and risk factors of the target cancers.
Summary
Key Message
- Scan-China is the first and largest electronic health data (EHD)-integrated cancer screening program for the Mongolian ethnicity in Inner Mongolia. - Scan-China aims to evaluate the effectiveness of screening interventions, particularly on ethnic minorities, portray the natural history, explore risk factors and summarize treatment patterns and updated outcomes of prevalent tumors/other chronic diseases. - Scan-China database comprises baseline cancer risk assessment, screening tests results, active follow-up investigation for participants at high risk and EHD-integrated passive follow-up. Data sources for passive follow-up include healthcare insurance database, cancer registry, front page of hospital medical record and death certificates.

Citations

Citations to this article as recorded by  
  • Higher disease burden and lower utilization in mongolian with breast cancer: a 9-year retrospective cohort study of 18.19 million adults in China
    Jieying Chen, Liying Qiao, Meng Qi, Yunjing Zhang, Ying Yan, Weiwei Kang, Huziwei Zhou, Yuelin Yu, Yalei Ke, Yuling Jiang, Yingting Rao, Lu Xu, Guohua He, Jing Ren, Xue Yan, Siwei Deng, Xinyu Yang, Yutong Song, Yingzi Yang, Qiaorui Wen, Jing Han, Yiwei Wu
    International Journal of Surgery.2024;[Epub]     CrossRef
Original Articles
Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020
Soo Yeon Song, Yun Yeong Lee, Hye Young Shin, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun
Epidemiol Health. 2022;44:e2022111.   Published online November 24, 2022
DOI: https://doi.org/10.4178/epih.e2022111
  • 5,677 View
  • 162 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported trends in the screening rate among Korean women from 2005 to 2020, including organized and opportunistic screening for breast cancer.
METHODS
Data from the Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, were collected using a structured questionnaire between 2005 and 2020. The study population included 23,702 women aged 40-74 years with no history of cancer. We estimated the screening rate based on the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates among various subgroups.
RESULTS
In 2020, the breast cancer screening rate was 63.5%, reflecting an annual increase of 7.72% (95% confidence interval 5.53 to 9.95) between 2005 and 2012, followed by non-significant trends thereafter. In particular, a significant decrease in the breast cancer screening rate was observed in the subgroups aged 50-59 years old, with 12-15 years of education, and living in rural areas.
CONCLUSIONS
Although there has been substantial improvement in breast cancer screening rates in Korean women, the trend has flattened in recent years. Therefore, continual efforts are required to identify subgroups with unmet needs and solve barriers to the uptake of breast cancer screening.
Summary
Korean summary
본 연구는 2005년에서 2020년까지 암검진수검행태조사 자료를 이용하여 40세 이상의 우리나라 여성의 유방암 검진 수검률이 추이에 대해 분석하였다. 우리나라 유방암 검진 수검률은 2020년 현재 63.5%이다. 하지만 지속적으로 증가하던 유방암 검진 수검률의 추이는 2012년 이후 정체되어 있으며 일부 사회경제적 계층에서는 감소하는 경향을 보였다.
Key Message
In Korea, despite of the high level of breast cancer screening rate, decreasing trends in some socioeconomic classes after 2012. Continual efforts are required to identify subgroup with unmet needs and barriers to the uptake of breast cancer screening.

Citations

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  • Current and future burden of breast cancer in Asia: A GLOBOCAN data analysis for 2022 and 2050
    Mengxia Fu, Zhiming Peng, Min Wu, Dapeng Lv, Yanping Li, Shuzhen Lyu
    The Breast.2025; 79: 103835.     CrossRef
  • Exploring age-standardized cancer incidence rates and regional disparities: A retrospective cohort study of 8 major cancers in South Korea
    Dagyeong Lee, Hye-won Yun, Nayeon Kim, Juwon Park, Kyu-won Jung, Mina Suh, Dong Wook Shin
    Cancer Epidemiology.2024; 91: 102594.     CrossRef
  • A cross-national investigation of CT, MRI, PET, mammography, and radiation therapy resources and utilization
    Takahiro Aoyama, Yutaro Koide, Hidetoshi Shimizu, Atsushi Urikura, Tomoki Kitagawa, Shingo Hashimoto, Hiroyuki Tachibana, Takeshi Kodaira
    Japanese Journal of Radiology.2024;[Epub]     CrossRef
  • Contrasting income-based inequalities in incidence and mortality of breast cancer in South Korea, 2006–2015
    Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi
    Epidemiology and Health.2024; : e2024074.     CrossRef
  • Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption
    Charlotte Poon, Tim Wilsdon, Iqra Sarwar, Alexander Roediger, Megan Yuan
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Mammographic Breast Density and Risk of Ovarian Cancer in Korean Women
    Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park
    Cancer Epidemiology, Biomarkers & Prevention.2023; 32(12): 1690.     CrossRef
Effect of mammography screening on the long-term survival of breast cancer patients: results from the National Cancer Screening Program in Korea
Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu-Won Jung, Kui Son Choi
Epidemiol Health. 2022;44:e2022094.   Published online October 26, 2022
DOI: https://doi.org/10.4178/epih.e2022094
  • 5,677 View
  • 183 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the effect of mammography screening on the long-term survival of breast cancer (BC) patients aged 40 years or older according to their screening history and duration since screening.
METHODS
The study cohort was organized from 3 nationwide databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. We included 24,387 women diagnosed with invasive BC or ductal carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019. Cox proportional-hazards regression was used to investigate the effect of BC screening on the risk of death.
RESULTS
Overall, 20,916 of 24,387 patients (85.8%) were alive at the end of the follow-up period (median: 10.5 years). The long-term survival rate was significantly lower in the never-screened group (80.3%) than in the screened group (88.9%) (p<0.001). A 35% reduction in the risk of BC death (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.60 to 0.70) from screening was observed. A subgroup analysis according to the cancer stage showed 62%, 36%, and 24% lower risks of BC death for the localized stage, regional stage, and distant stage, respectively. Women aged 40-49 years received the least benefit from BC screening (HR, 0.71; 95% CI, 0.62 to 0.81).
CONCLUSIONS
Mammography screening was effective in reducing the risk of BC-specific death in Asian women across all cancer stages. However, this effect was relatively small among women in their 40s, suggesting that more detailed and specialized screening strategies are needed for that age group.
Summary

Citations

Citations to this article as recorded by  
  • A Retrospective Analysis of Breast Cancer Mortality among Jewish and Muslim Arab Women in Israel: The Role of Sociodemographic Factors
    Ronit Pinchas-Mizrachi, Dan Bouhnik
    Cancers.2024; 16(15): 2763.     CrossRef
Effect of Pap smears on the long-term survival of cervical cancer patients: a nationwide population-based cohort study in Korea
Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, kyu-won Jung, Myong Cheol Lim, Kui Son Choi
Epidemiol Health. 2022;44:e2022072.   Published online September 7, 2022
DOI: https://doi.org/10.4178/epih.e2022072
  • 5,844 View
  • 116 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate the effect of cervical cancer screening by Papanicolaou (Pap) smears on the long-term survival of cervical cancer patients.
METHODS
We constructed a retrospective cohort of 14,903 women diagnosed with invasive cancer or carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019, by using individual-level data from 3 national databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. Cox proportional-hazards regression was used to investigate the effect of cervical cancer screening on mortality.
RESULTS
In total, 12,987 out of 14,867 patients (87.4%) were alive at the end of the follow-up period (median: 10.5 years). Screened patients had a 38% lower risk of cervical cancer death than never-screened patients (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54 to 0.70). Screening was associated with 59% and 35% lower risks of death, respectively, in screened patients with localized and regional stages. Furthermore, lower HRs among women who received screening were observed in all age groups, especially women aged 50–59 years (HR, 0.54; 95% CI, 0.42 to 0.69). The lowest HR for cervical cancer death was reported among patients screened within the past 2 years (HR, 0.54; 95% CI, 0.47 to 0.63), and the HRs increased with increasing time intervals.
CONCLUSIONS
Pap smear screening significantly reduced the risk of cervical cancer-specific death in Korean women across all cancer stages.
Summary
Korean summary
한국은 자궁경부암 발생과 사망을 낮추기 위하여 국가암검진사업으로 자궁경부암 검진을 실시하고 있다. 이 연구는 2008-2009년 자궁경부암 진단을 받은 30세-79세 14,903명을 대상으로 과거 자궁경부세포검진 여부에 따른 장기생존율을 추적 조사하였다. 그 결과 자궁경부암 검진을 받은 환자에서 사망 위험비가 약 38% 낮았으며, 2년 이내에 검진을 받은 환자군에서 사망 위험이 가장 낮았다.
Key Message
The Korean National Cancer Screening Program (KNCSP) has provided cervical cancer screening by Pap smear test. However, the survival, particularly long-term survival of cervical cancer patients, has never been evaluated in the KNCSP. This study reports a significant improvement in the long-term survival of screened cervical cancer patients, which persist in subgroup analysis by cancer stage. Patients who were screened within two years before the diagnosis had the best survival.

Citations

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  • The significance of uterine artery embolization in the treatment of utero‐cervical cancer: A single case report
    Preeti Kumari Yadav, Abhimanyu Sharma, Muhammad Ali, Nida Khan, Jubran Al Balushi, Hajrah Farooq, Sree Abhilekha Purohit, Sofia Ali, Malavika Jayan, Archit Kumar Nigam, Mansi Singh
    Clinical Case Reports.2024;[Epub]     CrossRef
  • Time to death from cervical cancer and its predictors in hospitalized patients: a survival approach study in Mato Grosso, Brazil
    Sancho Pedro Xavier, Kátia Moreira da Silva, Noemi Dreyer Galvão, Marco Aurélio Bertúlio das Neves, Adila de Queiroz Neves Almeida, Ageo Mario Cândido da Silva
    World Journal of Surgical Oncology.2024;[Epub]     CrossRef
The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea
Hyeree Park, Seung Hee Seo, Jong Heon Park, Shin Hye Yoo, Bhumsuk Keam, Aesun Shin
Epidemiol Health. 2022;44:e2022053.   Published online June 21, 2022
DOI: https://doi.org/10.4178/epih.e2022053
  • 14,486 View
  • 462 Download
  • 16 Web of Science
  • 18 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening.
METHODS
Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals.
RESULTS
The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer).
CONCLUSIONS
After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.
Summary
Korean summary
본 연구는 코로나 대유행 기간 전과 후 대장암, 위암, 유방암, 자궁경부암 검진 수검률 차이를 비교하고자 하였다. 첫 코로나 확진자가 발생한 2020년을 코로나 대유행 기간, 전년도 기간인 2019년을 코로나 대유행 전 기간으로 설정하며 국민건강보험공단에서 집계된 전수자료를 이용하여 암 검진 대상자 수와 수검자 수를 비교 분석하였다. 4개 암종 모두에서 2019년도와 비교하여 2020년도에 전국적으로 수검률이 감소하는 경향이 있었으며, 1차 대유행이 있었던 3월과 3차 대유행 시기인 12월에 2019년도 동기간과 비교하여 수검률이 크게 감소하였고, 80대 이상 노인 인구에서 감소폭이 다른 연령대와 비교하여 크게 나타났다.
Key Message
We found decline of the colorectal, gastric, breast and cervical cancer screening participation rates in 2020 following the two major COVID-19 waves, compared with those of 2019, and the highest decline was observed in the elderly population aged 80 years and older.

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  • Emergency department visits of newly diagnosed cardiovascular disease patients in Korea during the COVID-19 pandemic
    Ji Yoon Baek, Seung Hee Seo, Sooyoung Cho, Jun-Bean Park, Bhumsuk Keam, Shin Hye Yoo, Aesun Shin
    Scientific Reports.2024;[Epub]     CrossRef
  • Decline in Cancer Diagnoses during the ‘Zero COVID’ Policy in Hong Kong: Indirect Spillover Impact of the COVID-19 Pandemic
    H.M. Youn, Y. Zhang, A. Liu, C.S. Ng, J. Liang, G.K.K. Lau, S.F. Lee, J. Lok, C.L.K. Lam, E.Y.F. Wan, J. Quan
    Clinical Oncology.2024; 36(3): 157.     CrossRef
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    Jinah Sim, Jihye Shin, Hyun Jeong Lee, Yeonseung Lee, Young Ae Kim, Chong-Chi Chiu
    PLOS ONE.2024; 19(2): e0296808.     CrossRef
  • Access to colorectal cancer screening in populations in China, 2020: A coverage‐focused synthesis analysis
    Yan‐Jie Li, Xin Wang, Yu‐Jie Wu, Xin‐Yi Zhou, Jibin Li, Jiangmei Qin, Wanghong Xu, Jie‐Bin Lew, Wanqing Chen, Ju‐Fang Shi
    International Journal of Cancer.2024; 155(3): 558.     CrossRef
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    Francisco Estupiñán-Romero, Santiago Royo-Sierra, Javier González-Galindo, Natalia Martínez-Lizaga, Petronille Bogaert, Nienke Schutte, Liesbet Van Eycken, Nancy Van Damme, Kris Henau, Ronan A Lyons, Sarah J Aldridge, Andrea Faragalli, Flavia Carle, Rosar
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    Armin Aslani, Amirali Soheili, Seyed Ehsan Mousavi, Ali Ebrahimi, Ryan Michael Antar, Zahra Yekta, Seyed Aria Nejadghaderi, Deepak Dhamnetiya
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    Kejia Ma, Xuejie Chen, Xin Xiang, Xueyi Mao, Ningxin Zhu, Tianyu Wang, Shuyu Ye, Xiaoyan Wang, Minzi Deng
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  • Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan
    Misuzu Fujita, Hideyuki Hashimoto, Kengo Nagashima, Kiminori Suzuki, Tokuzo Kasai, Kazuya Yamaguchi, Yoshihiro Onouchi, Daisuke Sato, Takehiko Fujisawa, Akira Hata
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    Seung Hee Seo, Sooyoung Cho, Shin Hye Yoo, Bhumsuk Keam, Aesun Shin
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    Catalin Vladut Ionut Feier, Alaviana Monique Faur, Calin Muntean, Andiana Blidari, Oana Elena Contes, Diana Raluca Streinu, Sorin Olariu
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    Moonki Hong, Mingee Choi, JiHyun Lee, Kyoo Hyun Kim, Hyunwook Kim, Choong-Kun Lee, Hyo Song Kim, Sun Young Rha, Gyu Young Pih, Yoon Jin Choi, Da Hyun Jung, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Minah Cho, Yoo Min Kim, Hyoung-Il Kim,
    Journal of Gastric Cancer.2023; 23(4): 574.     CrossRef
  • Socioeconomic inequality in organized and opportunistic screening for gastric cancer: results from the Korean National Cancer Screening Survey 2009–2022
    Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Impact of the COVID-19 Pandemic on Gastric Cancer Screening in South Korea: Results From the Korean National Cancer Screening Survey (2017–2021)
    Kyeongmin Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi
    Journal of Gastric Cancer.2022; 22(4): 297.     CrossRef
  • Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis
    Xiaoyan Wang, Yimeng Sun, Pei Wang, Yu Jie, Guodong Liu, Dandan Gong, Yu Fan
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020
    Soo Yeon Song, Yun Yeong Lee, Hye Young Shin, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun
    Epidemiology and Health.2022; 44: e2022111.     CrossRef
Changes in cancer screening before and during COVID‐19: findings from the Korean National Cancer Screening Survey 2019 and 2020
Thao Thi Kim Trinh, Yun Yeong Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi
Epidemiol Health. 2022;44:e2022051.   Published online May 30, 2022
DOI: https://doi.org/10.4178/epih.e2022051
  • 10,223 View
  • 376 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has negatively affected every aspect of medical care. However, information regarding the impact of the pandemic on cancer screening is lacking. This study aimed to explore cancer screening changes by geographic region before and during the pandemic in Korea.
METHODS
Korean National Cancer Screening Survey data for 2019 and 2020 were used. Changes in the screening rate before and during the COVID-19 pandemic were calculated by subtracting the rate in 2020 from the rate in 2019. Multivariate logistic regression analyses examined the differences in screening rates at the national and 16 provincial levels before and after the COVID-19 outbreak.
RESULTS
The 1-year screening rates for the four types of cancer decreased during the pandemic (stomach cancer: -5.1, colorectal cancer: -3.8, breast cancer: -2.5, cervical cancer: -1.5%p). In metropolitan areas, the odds of undergoing screening tests during the pandemic were significantly lower than before the pandemic for stomach (adjusted odds ratio [aOR], 0.66; 95% confidence interval [CI], 0.56 to 0.76), colorectal (aOR, 0.63; 95% CI, 0.50 to 0.79), and breast cancers (aOR, 0.75; 95% CI, 0.60 to 0.94). Furthermore, the likelihood of undergoing stomach cancer screening during the pandemic was significantly lower than before the pandemic in non-metropolitan urban areas (aOR, 0.81; 95% CI, 0.70 to 0.94), while it was higher in rural areas (aOR, 1.54; 95% CI, 1.10 to 2.16).
CONCLUSIONS
Since the COVID-19 pandemic, the cancer screening rate has decreased significantly, especially in large cities. Public health efforts are required to improve cancer screening rates.
Summary
Korean summary
• 코로나 대유행 이전과 이후의 최근 1년간 암검진 수검률을 비교한 결과, 위암 (5% 포인트), 대장암 (3.8% 포인트), 유방암 (2.5% 포인트), 자궁경부암 (1.5% 포인트) 수검률이 통계적으로 유의하게 감소하였음 • 특히 위암, 대장암, 유방암의 경우 대도시 지역에서의 수검률이 현저하게 감소하였음
Key Message
The 1-year screening rates for stomach, colorectal, breast, and cervical cancer decreased significantly during the pandemic in Korea, especially in large cities.

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The classification capability of the Asia Pacific Colorectal Screening score in Korea: an analysis of the Cancer Screenee Cohort
Xuan Quy Luu, Kyeongmin Lee, Jeongseon Kim, Dae Kyung Sohn, Aesun Shin, Kui Son Choi
Epidemiol Health. 2021;43:e2021069.   Published online September 16, 2021
DOI: https://doi.org/10.4178/epih.e2021069
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  • 223 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to validate a simple risk assessment tool for estimating the advanced colorectal neoplasia (ACN) risk at colonoscopy screenings and potential factors relevant for implementing this tool in the Korean population.
METHODS
Our study analyzed data from the Cancer Screenee Cohort Study conducted by the National Cancer Center in Korea. The risk level was assessed using the Asia Pacific Colorectal Screening (APCS) score developed by the Asia-Pacific Working Group on Colorectal Cancer. Logistic regression models were used to examine the associations between colorectal-related outcomes and the risk level by APCS score. The discriminatory performance of the APCS score for various colorectal-related outcomes was assessed using C-statistics.
RESULTS
In 12,520 individuals, 317 ACN cases and 4,528 adenoma cases were found. The APCS tool successfully classified the study population into different risk groups, and significant differences in the ACN rate and other outcomes were observed. The APCS score demonstrated acceptable discrimination capability with area under the curve values ranging from 0.62 to 0.65 for various outcomes. The results of the multivariate logistic regression model revealed that the high-risk group had a 3.1-fold higher risk of ACN (95% confidence interval, 2.08 to 4.67) than the average-risk group. Body mass index (BMI) was identified as a significant predictor of ACN in both multivariate and subgroup analyses.
CONCLUSIONS
Our study highlighted significant differences in colorectal-related screening outcomes by colorectal risk level measured using the APCS score, and BMI could be used to improve the discriminatory capability of the APCS score.
Summary
Korean summary
검진의 위해성을 줄이면서 동시에 이득을 최대화할 수 있는 최적의 검진 프로그램은 암 발생 위험도를 고려하는 것이다. 이 연구는 Asia-Pacific Working Group on Colorectal Cancer에서 제안한 “Asia Pacific Colorectal Screening Score (APCS)”가 한국인에서 대장암 발생 위험도를 선별적으로 잘 구분해 낼 수 있음을 보여주었다. 나아가 대장암의 위험도 점수를 산출하는데 체질량지수가 중요한 예측 변수라는 것을 확인하였고, 한국인에서 대장암 발생 위험도의 변별력을 향상시키기 위해 기존의 APCS에 체질량지수를 추가할 것을 제안하였다.
Key Message
This study highlighted that the Asia Pacific Colorectal Screening Score by the Asia-Pacific Working Group on Colorectal Cancer could successfully classify Korean screenees into different risk groups with acceptable discriminatory capability. Furthermore, our study results also suggest that BMI is a significant predictor of colorectal-related health outcomes, which could be potentially added to the original APCS score for improving its discriminatory power.

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  • Performance of the Asia–Pacific Colorectal Screening score in stratifying the risk of advanced colorectal neoplasia: A meta‐analysis and systematic review
    Mai Ngoc Luu, Nhi Ai Trinh, Truc Le Thanh Tran, Thinh Phuong Dang, Toru Hiyama, Duc Trong Quach
    Journal of Gastroenterology and Hepatology.2024; 39(6): 1000.     CrossRef
  • Developing a Nomogram for Predicting Colorectal Cancer and Its Precancerous Lesions Based on Data from Three Non-Invasive Screening Tools, APCS, FIT, and sDNA
    Yuan Ze, Hui-Ming Tu, Yuan-Yuan Zhao, Lin Zhang
    Journal of Multidisciplinary Healthcare.2024; Volume 17: 2891.     CrossRef
  • Predicting the risk of colorectal cancer among diabetes patients using a random survival forest-guided approach
    Sarah Tsz Yui Yau, Chi Tim Hung, Eman Yee Man Leung, Ka Chun Chong, Albert Lee, Eng Kiong Yeoh
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • A Comparison of Single and Combined Schemes of Asia-Pacific Colorectal Screening, Faecal Immunochemical and Stool Deoxyribonucleic Acid Testing for Community Colorectal Cancer Screening
    Yuan Ze, Huiming Tu, Lin Zhang, Yu Bai, Yilin Ren, Xin Chen, Yuzheng Xue, Renjuan Sun, Yuling Yang, Jie Yang, Xuan Zhou, Li Liu
    Journal of Multidisciplinary Healthcare.2023; Volume 16: 571.     CrossRef
  • Advances in Screening Methods for Colorectal Cancer
    碗宜 张
    Advances in Clinical Medicine.2023; 13(03): 2995.     CrossRef
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    Deborah Jael Herrera, Wessel van de Veerdonk, Daiane Maria Seibert, Moges Muluneh Boke, Claudia Gutiérrez-Ortiz, Nigus Bililign Yimer, Karen Feyen, Allegra Ferrari, Guido Van Hal
    Gastrointestinal Disorders.2023; 5(4): 549.     CrossRef
  • Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009–2021
    Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi
    Epidemiology and Health.2023; : e2023086.     CrossRef
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Distribution of dense breasts using screening mammography in Korean women: a retrospective observational study
Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim, Yoon-Nam Kim, Chung Mo Nam
Epidemiol Health. 2014;36:e2014027.   Published online November 4, 2014
DOI: https://doi.org/10.4178/epih/e2014027
  • 18,977 View
  • 144 Download
  • 16 Web of Science
  • 13 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
This retrospective observational study evaluated the distribution of dense breasts by age group among healthy Korean women.
METHODS
Participants were women aged 30 years and older who voluntarily underwent screening mammography between January 2007 and December 2011. Women who received the Breast Imaging Reporting and Data System for mammographic density of 3 or 4 were defined as having dense breasts. The proportion of women with dense breasts (PDB, %) was calculated by dividing the number of participants with dense breasts by the total number of participants.
RESULTS
Among the 231,058 women who participated, 78.15% were classified as having dense breasts. PDB was highest in the youngest age group (PDB=94.87%) and lowest in the oldest age group. The greatest difference in PDB between adjacent age groups was observed in the group aged 60-64 years.
CONCLUSIONS
The results show that the proportion of dense breasts by age group increased in all age groups, except in those aged 35-39 years. These findings suggest an association between the age distribution of dense breasts and trends in breast cancer incidence. Further studies are needed to estimate the change in breast cancer incidence rate by age and the accumulation of fatty breast tissue in Korean women.
Summary

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Review
Methodological Review of Cost Effectiveness Analysis of Cancer Screening.
Ki Taig Jung
Korean J Epidemiol. 1998;20(1):13-31.
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AbstractAbstract PDF
Abstract
The role of economic evaluation for medical services can be summarixed as providing objective criteria for rational bgudget allocation. With medical and epidemiologial studies, cost effectiveness analysis of cancer screening will provide evidence for allocating more financial resources for cancer screening. This study reviewed comprehensive literature of cancer screening for cervical cancer and breast cancer. Through the extensive review of the literature, I suggest crucial issues of cancer screening and checkpoints in designing costeffectiveness analyses of cervical and breast cancers. The issues of cervical and breast cancer screening include ages of starting and terminating mass screening, screening interval and frequency, false positive rate, false negative rate, analytical models, and sensitivity analysis. In addition, cost effectiveness analysis of breast cancer should consider effects of screening methods-self examination, clinical examination, and mammography-that varies across different nations on cost effectiveness ratio. Study results of most issues would be relevant for performing cost effectiveness analysis of cancer screening in Korea. However, difference in incidence rate, medical fees and reimbursement by insurance across nations should be considered in designing cost effectiveness analysis.
Summary

Epidemiol Health : Epidemiology and Health
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